PI-RADS 3-5 lesions MRI pattern after Prostate Artery Embolization

Objectives To evaluate changes in PI-RADS ≥ 3 lesions on prostate MRI after prostate artery embolization (PAE) performed for lower urinary tract symptoms. Methods This retrospective single-center study included 18 consecutive patients, each presenting with 1 PI-RADS ≥ 3 prostatic images on pre-PAE MRI and who underwent follow-up MRI after PAE. We assessed changes in PI-RADS score, infarcted areas, and prostate volume. Results Before PAE, all 18 lesions (mean PSA density : 0,078) were either biopsy-negative (n = 4) or deemed not requiring biopsy based on multidisciplinary consensus (n = 12), except for 1 case of non-clinically significant prostate cancer identified before PAE and 1 patient with a PIRADS 4 lesion who declined biopsy. The mean delay to post-PAE MRI was 120 days. After PAE, no new PI-RADS ≥ 3 lesions appeared, and no lesion was upgraded. Both initially classified as PI-RADS 5 lesions (negative on biopsies) were downgraded to PI-RADS 1. Among the 6 PI-RADS 4 lesions, 3 remained stable, 2 were downgraded to PI-RADS 3 and 1 to PI-RADS 2. Of the 10 PI-RADS 3 lesions, 8 achieved PI-RADS 1 status and 2 remained stable. Conclusions Following PAE, pre-existing PI-RADS ≥ 3 lesions demonstrate stability or reduction in PI-RADS on MRI. However, radiopathological correlation studies are warranted to estimate the diagnostic reliability of the PI-RADS score in the post-PAE settings Advances in knowledge This study shows that PI-RADS ≥ 3 images are downgraded after PAE. It doesn’t imply that potential prostate cancer can be cured by PAE.